St. Mary Parish - Derby OCIA 2026-2027 Registration Form
Basic Information
Name
*
First Name (No Nicknames)
Middle Name
Last Name
Suffix
Nickname (if preferred)
Gender
*
Male
Female
Date of Birth
*
-
Month
-
Day
Year
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Place of Birth
*
Father's Full Name
*
Mother's Full Maiden Name
*
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Contact Information
Full Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
How do you prefer to be contacted?
*
Call
Text
Email
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Religious History
What, if any, is your present religious affiliation?
*
Have you ever been baptized?
*
Yes
No
I am not sure
Please Explain:
*
In what denomination were you baptized?
Date of your approximate age when you were baptized:
Baptismal name:
If different from current name
Place of Baptism:
Name of church/denomination
Address, if known:
Location, if known:
Include locality (town, city, country, etc.), region (state, province, etc.), and country.
Were you baptized as a Catholic?
*
Yes
No
Check those sacraments you have already received:
*
Penance (Confession)
Eucharist (First Communion)
Confirmation
I'm Not Sure
Please Explain:
*
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Current Marital Status
Check the appropriate statement(s) below and provide any information requested beneath each statement.
*
I have never been married
I am engaged to be married
I am married
I am married, but separated from my spouse
I am divorced and I have not remarried
I am a widow/widower and have not remarried since my spouse's death
Maiden Name (if applicable)
Your Fiancé's Full Name
*
Your Fiancés Current Religious Affiliation (if any)
*
For you:
*
This is my first marriage
I have been married before
For your fiancé
*
This is his/her first marriage
My fiancé has been married before
Your Spouse's Full Name:
*
Your Spouse's Current Religious Affiliation (if any):
*
For you:
*
This is my first marriage
I have been married before
For your spouse:
*
This is my spouse's first marriage
My spouse has been married before
Date of Marriage:
*
-
Month
-
Day
Year
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Place of Marriage:
*
Include locality (town, city, country, etc.), region (state, province, etc.), and country.
Officiating Authority of Marriage:
*
(i.e., civil government/courthouse, non-Christian minister, Christian minister, Catholic cleric)
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Family Information
Do you have any children or dependents?
*
Yes
No
Please list the relationship, names, and ages of any children or dependents:
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General Questions
What or who has led you to want to know more about the Catholic Faith?
Please describe the types of religious education you have received, as a child and as an adult.
What contact have you had with the Catholic Church to date?
What are some of the questions or concerns you have about the Catholic Church?
At this point in time, which of the following statements best describes your present feelings and thoughts about the possibility of joining the Catholic Church?
*
I need much more information about the Catholic Church before I would consider joining.
I am considering joining, but I am still unsure about it.
I am fairly sure that I would like to join, but I still need some time to study and pray about it.
I am fairly sure that I want to join the Catholic Church.
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